EmailMe Form - Rising Star Award

Name of Nominee *

First Last

Academic/Professional Credentials *

Title *

Employer *

Phone *

### - ### - ####

Email *

Nominee is a current ASPMN Member *

Yes

No

Years of Practice in pain management: *

ASPMN Involvement: *

If not addressed in the letter of recommendation, please describe how the nominee demonstrates the following:

1. Demonstrates the potential for leadership and outstanding contribution to the field of pain management nursing.

2. Demonstrates leadership in promoting excellence in pain care (ie. nursing practice, policy review/revision, education, evidence-based practice, research, role model for patient pain care/advocacy.) *

Nominee's current cv *

Letter of Recommendation *

Letters of recommendation should not exceed two pages and should describe the nominees excellence and potential.

Nominated by: *

First Last

Phone *

### - ### - ####

Email *